Incidence of and risk factors for suspected and definitive glaucoma after bilateral congenital cataract surgery: a 5-year follow-up
Incidence of and risk factors for suspected and definitive glaucoma after bilateral congenital cataract surgery: a 5-year follow-up
复制标题
DOI：
10.1136/bjo-2022-322589
复制
发表时间：
2023-02-23
影响因子：
4.1
通讯作者：
Chen, Weirong
中科院分区：
文献类型：
--
作者：
Wang, Jinghui;Wu, Xianghua;Chen, Weirong
目的报告双侧先天性白内障（CC）摘除术后5年随访的疑似和确诊青光眼的发病率和相关危险因素。方法前瞻性纵向队列研究的二次分析。招募2011年1月至2014年12月在中山眼科中心接受白内障手术的双侧CC患者。疑似青光眼定义为需要药物治疗的持续性高眼压。青光眼定义为伴有青光眼临床特征的进展。根据术后5年随访的透镜状态：无晶状体眼组130眼，一期人工透镜（IOL）植入组219眼，二期IOL植入组337眼。采用Kaplan-Meier生存分析和考克斯回归分析方法，对可疑青光眼和确诊青光眼的累积发病率和危险因素进行分析。手术时的平均年龄为1.82 ± 2.08岁，平均随访时间为6.26 ± 0.97年。术后平均2.8 ± 1.75年（范围0.02-7.33年）出现疑似和确定性青光眼。可疑和确诊青光眼的累积发生率为9.97%（35/351），其中确诊青光眼为6.12%（42只眼），可疑青光眼为2.48%（17只眼）。小角膜（HR 4.103，p < 0.0001）、CC家族史（HR 3.285，p=0.001）和初始前部玻璃体切除术（HR 2.365，p=0.036）是疑似和确定性青光眼的危险因素。性别、手术年龄、眼内手术频率、随访时间和掺钕钇铝石榴石激光频率无统计学意义。结论对儿童行双侧CC手术后可疑青光眼和确诊青光眼进行鉴别诊断，可降低继发性盲的风险。在临床实践中，对存在相关危险因素的患者应给予更多关注，从而达到早期干预和治疗。一期人工晶状体植入可能是一个潜在的保护因素，需要更多的临床试验来验证。
Aims To report the incidence and associated risk factors for developing suspected and definitive glaucoma after bilateral congenital cataract (CC) removal with a 5-year follow-up.Methods Secondary analysis of a prospective longitudinal cohort study. Bilateral CC patients who had undergone cataract surgery between January 2011 and December 2014 at Zhongshan Ophthalmic Centre were recruited. Suspected glaucoma was defined as persistent ocular hypertension requiring medical treatment. Definitive glaucoma was defined as accompanied by the progression of glaucomatous clinical features. According to postoperative lens status in 5 years follow-up: 130 eyes in the aphakia group; 219 in the primary intraocular lens (IOL) implantation group and 337 in the secondary IOL implantation group. The Kaplan-Meier survival and Cox regression analyses were used to explore the cumulative incidence and risk factors for suspected and definitive glaucoma.Results Three hundred fifty-one children (686 eyes) with bilateral CCs were enrolled in the study. The mean age at surgery was 1.82 +/- 2.08 years, and the mean follow-up duration was 6.26 +/- 0.97 years. Suspected and definitive glaucoma developed at a mean time of 2.8 +/- 1.75 years (range 0.02-7.33 years) postoperatively. The cumulative incidence of suspected and definitive glaucoma was 9.97% (35 of 351 patients), including 6.12% (42 eyes) for definitive glaucoma and 2.48% (17 eyes) for suspected glaucoma. Microcornea (HR 4.103, p < 0.0001), CC family history (HR 3.285, p=0.001) and initial anterior vitrectomy (HR 2.365 p=0.036) were risk factors for suspected and definitive glaucoma. Gender, age at surgery, intraocular surgery frequency, length of follow-up and frequency of neodymium-doped yttrium aluminumaluminium garnet laser were non-statistically significant. Primary IOL implantation was a protective factor (HR 0.378, p=0.007).Conclusions Identifying suspected and definitive glaucoma after bilateral CC surgery can lower the risk of secondary blindness in children. Patients with related risk factors need to pay more attention and thus reach early intervention and treatment during clinical practice. Primary IOL implantation may be a potential protective factor, need more clinical trials to be verified.